Abstract
In several countries, primary care for pregnant women is performed by obstetric nurses and/or midwives. In Brazil's Supplementary Health System (private health insurance and out-of-pocket care), coverage of prenatal care is mandatory and is performed by medical obstetricians. The objective of this study is to conduct a cost-effectiveness analysis, comparing clinical outcomes and costs associated with the incorporation of prenatal care by obstetric nurses and midwives in the Supplementary Health System, from the perspective of the operator of health plans as the payment source. A decision tree was built, based on data from a Cochrane Collaboration meta-analysis that showed a reduction in the risk of premature birth in the group of normal-risk pregnant women accompanied by obstetric nurses and midwives. The analysis only considered the direct medical costs covered by health plan operators for essential appointments and tests, according to the prevailing Ministry of Health protocol. The study assumed equal unit costs of consultations by medical professionals and applied an increase in the overall cost of prenatal tests associated with medical follow-up, based on data from the literature. Incremental cost-effective ratio was estimated at -BRL 10,038.43 (savings of BRL 10,038.43) per premature birth avoided. This result was consistent with the sensitivity analyses, with savings associated with the substitution ranging from -BRL 2,544.60 to -BRL 31,807.46 per premature death avoided. In conclusion, prenatal care provided by obstetric nurses and midwives was superior to that provided by medical obstetricians for the prevention of premature birth, besides resulting in cost savings.
Highlights
Em relação aos parâmetros clínicos para a construção do modelo, foi utilizada a redução na taxa de parto prematuro, em específico os resultados para a análise de subgrupo para gestantes de baixo risco
O estudo foi uma avaliação de custo-efetividade aninhada ao ensaio clínico randomizado de Tucker et al 19, que comparou os desfechos clínicos do pré-natal com parteiras profissionais versus médicos obstetras na Escócia, com base nos dados de custos médicos diretos de 1.667 gestantes de risco habitual
Souza J, Gulmezoglu AM, Lumbiganon P, Laopaiboon M, Carrin G, Fawole B, et al Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health
Summary
A atenção primária às gestantes é conduzida por enfermeiras obstetras e/ou obstetrizes. O objetivo deste estudo é conduzir análise de custo-efetividade, comparando desfechos clínicos e custos associados à incorporação do pré-natal por enfermeiras obstetras e obstetrizes no âmbito do Sistema de Saúde Suplementar, sob a perspectiva da operadora de planos de saúde como fonte pagadora. O objetivo deste estudo é conduzir avaliação econômica de custo-efetividade para comparar desfechos clínicos e custos associados à incorporação do acompanhamento pré-natal realizado por enfermeiras obstetras e/ou obstetrizes no âmbito do Sistema de Saúde Suplementar, adotando a perspectiva da operadora de planos de saúde como fonte pagadora. Consideramos, para esta análise, o desfecho de taxa de partos prematuros, de modo que os custos incrementais da nova tecnologia (pré-natal com enfermeiras obstetras e/ou obstetrizes) foram ponderados pela redução no número de partos prematuros, de modo que a RCEI foi expressa como custo por parto prematuro evitado. Dado o curto prazo para a identificação do desfecho de interesse, foi adotado horizonte de tempo de 1 ano, não sendo aplicável, neste caso, taxa de desconto
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